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Health Care – When Disaster Strikes

Almost seven years post the attacks of September 11th, one of the serious preparedness issues still facing the country is the state of its health care, especially hospital trauma centers that would not be able to deal with the surge of patients resulting from a mass casualty terrorist attack.

A recent controversial inquiry into the disaster preparedness of hospitals concluded that they are -- and will be -- incapable to handle even a modest terrorist attack in those cities (none of the 34 hospitals in the survey by the House Committee on Oversight and Government Reform found that none of them were found ready to act at the moment of an attack); one reason for the lack of hospitals' capacity was cited as the Administration’s cuts in Medicaid reimbursements that in turn create overcrowding in emergency rooms, compromising the hospital’s ability to absorb and treat disaster victims.

"The situation in Washington, D.C. and Los Angeles was particularly dire. There was no available space in the emergency rooms at the main trauma centers serving Washington, D.C. One emergency room was operating at over 200 percent of capacity - If a terrorist attack had occurred in Washington, D.C. or Los Angeles on March 25 when we did our survey, the consequences could have been catastrophic. The emergency care systems were stretched to the breaking point and had no capacity to respond to a surge of victims."

The study has been denounced by Congressional Republicans as a “political stunt”. In response to the survey, Representative Christopher Shays (R-Connecticut) said "We cannot afford to build and maintain idle trauma facilities, waiting for the tragic day we pray never comes."

Dr. Richard Bradley, an emergency physician and chief of the division for EMS and disaster medicine at the the University of Texas Health Science Center at Houston, said it's incorrect to assume the city can't handle a surge simply because emergency rooms here often operate at capacity.

Related, we also learn that in the May edition of Chest, the Journal of the American College of Chest Physicians, disaster triage recommendations are made.

Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

- Those with severe trauma, which could include critical injuries from car crashes and shootings
- People older than 85
- Severely burned patients older than 60
- Those with severe mental impairment, which could include advanced Alzheimer's disease
- Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes

The ability of our health system to deal with a man-made or natural disaster should not become a political football. Even though these “recommendations” are problematic and likely violate federal laws against age discrimination and disability discrimination, along with other ethical and moral issues, the likelihood is that health care rationing will be needed in the event of a mass casualty disaster.

3 Comments

Why is this news?? We, in the medical community, have ALWAYS triaged, including today, Mother's Day, in all ED's. We do the most good for the most people. In the event of trauma, those above 65 have a 50% mortality, even in the best trauma center ("kids bounce, elderly don't").

This may seem harsh but I work with reality, not what people wished.

BTW, a disaster is defined as anytime your casualties outstrip your resources. So even a school bus wreck with 45 kids on-board can be a disaster in a rural environment. In this case, if 2 paramedics are on-scene and 4 students have traumatic amputations with profuse bleeding and 4 students have tracheal injuries, occluding their airway, decisions MUST be made. Some will die while you try to save the most number.

Sounds harsh, maybe, but it is the real world.

To conduct a study on the disaster preparedness of hospitals is prudent.

To link levels of unpreparedness to Medicaid cuts??? Absolutely shameful. As if - in a time of a disaster/mass casualty attack - any number of non-critical emergency room patients would hinder in any meaningful way the treatment of the critically injured.

Perhaps the ER medical staff are too thick and incapable of discerning priority without due and proper guidance from elected US Senate and House experts.

It's like reading Michael Scheuer. Great research, and invaluable data. But when it comes to using the data to reach conclusions, causation or predictions, it's time to turn the page.

As I wrote, disaster planning and hospital and medical resources should be a priority, not a political football. This post purposely mentioned both sides.

But the facts continue to be (not just the report done for the Democrats) that our medical facilities are not prepared. Why? Largely because there is no way to prepare for the inevitable but unpredictable. As Congressman Shays said, “We cannot afford to build and maintain idle trauma facilities, waiting for the tragic day we pray never comes.”